Abstract
<p>Pseudomonas aeruginosa infections are a major cause of morbidity and mortality among solid organ transplant (SOT) recipients, particularly in the context of increasing antimicrobial resistance. Pneumonias and bloodstream infections (BSIs) caused by multidrug-resistant (MDR) or difficult-to-treat resistant (DTR) strains represent significant therapeutic and prognostic challenges in this vulnerable population. The review will include randomized controlled trials and observational studies published up to April 30, 2026, identified through systematic searches of PubMed, Embase, and Scopus. Studies reporting data on pneumonias and BSIs caused by P. aeruginosa in the kidney, liver, lung, heart, or other solid organ transplant recipients will be considered eligible. The primary outcome will be 30-day all-cause mortality, while secondary outcomes will include clinical cure, recurrence rates, graft failure, and intensive care unit admission. Special attention will be given to comparisons between MDR and non-MDR isolates, as well as to the evaluation of different treatment strategies, including monotherapy versus combination therapy, the use of novel antibiotics, and adjunctive aerosolized antibiotic therapy. Data will be synthesized through narrative analysis and, where appropriate, random-effects meta-analysis. Subgroup analyses are planned according to resistance profile, transplant type, clinical severity, and geographical region. This review aims to provide an updated synthesis of the available evidence on the clinical burden of resistant P. aeruginosa infections in SOT recipients and to identify treatment approaches and prognostic factors associated with improved clinical outcomes.</p>